Addressing the poor medication adherence in prevention of cardiovascular mortality and morbidity in Australia: development of a clinical decision support tool (phase 1)

Addressing the poor medication adherence in prevention of cardiovascular mortality and morbidity in Australia: development of a clinical decision support tool (phase 1)

Chief Investigators

Talic Stella, Ademi Delaney Zanfina, Liew Danny, Bell Simon, Reid Christopher, Green Sally, Ilomaki Jenni, Zomer Ella, Berkovic Danielle, Lybrand Sean, and Stratton Giles

Estimated completion date

31 May 2026

Background

Poor adherence to lipid lowering therapies is linked to significantly increased risk of cardiovascular events and death. Unfortunately, adherence to statins in Australia is far from optimal; with half of the patients not taking their medications as prescribed. Furthermore, nearly two thirds thirds of Australians failed to achieve national lipid management targets even after 24 months of statin therapy.

The growing burden of CVD on morbidity imposes financial stress on the national health resource, which funds millions of dollars for lipid lowering therapies annually. Given the well-established cumulative damaging effect of high LDL-C levels the impact of not adhering or delaying lipid lowering therapy directly leads to lost therapeutic benefit and a waste of resources.

This project will address critical evidence and knowledge gaps related to pharmacoepidemiology and risk of nonadherence to lipid lowering medications in Australian adults by harnessing the power of contemporary real-world data derived from primary health practices and supplemented by a qualitative exploration of patient, system, disease and clinical level factors. Given the current established link between nonadherence to LLM and CVD morbidity and mortality we aim that by addressing one of the most neglected risk factors (i.e. nonadherence to medications) we will be able to reduce the number of people developing CVD. This will enable us to develop tailored clinical decision support tool that identifies those that are likely to be nonadherent and integrates consumer developed and tailored prevention strategies to prevent further nonadherence related CVD morbidity and mortality.

Aims

  1. Identify and assess risk factors associated with nonadherence and adherence to lipid lowering therapies in Australian adults in primary health practices.
  2. Identify and evaluate patient, system, condition and therapy barriers and enablers to nonadherence to lipid lowering therapies.
  3. Develop and evaluate a screening tool to identify individuals at highest risk of nonadherence to lipid lowering therapies so that prevention strategies can be timely and successfully actioned.
  4. Develop an evidence-based clinical decision support tool incorporating preventative strategies for nonadherence to aid shared professional-patient decision making in addressing nonadherence to lipid lowering therapies.
  5. Assess stakeholder acceptability of incorporating a clinical decision tool approach as part of key performance indicators for primary healthcare provision in Australia.

Methods

  1. Project 1: A retrospective cohort study will be conducted to identify the types, trajectories and pathways of nonadherence, as well as comprehensive risk profile, in patients at risk of or with cardiovascular disease on lipid lowering therapies
  2. Project 2: A qualitative exploratory study will be conducted to identify patients’ perspectives on barriers and enablers to adherence and reasons for poor/nonadherence.
  3. Project 3: A full risk profile and risk prediction tool will be developed to aid in the identification of those at highest risk for nonadherence to lipid lowering therapies
  4. Project 4: A Nominal Group Technique (NGT) study will be conducted to develop a decision support tool that include a set of preventative strategies that are tailored, feasible, sustainable and relevant for implementation in Australian primary health practices.
  5. Project 5: A mixed-methods study will be conducted with primary health professionals and patients to assess acceptability, feasibility and ability to implement the decision support tool as part of key performance indicators for primary healthcare provision in Australia

Proposed outputs

  • C Nash, M Mortner, Trin C, I Buzancic, D Belec, N Evans, S Talic – Do clinical decision support tools improve quality of care outcomes in primary CVD prevention?: a systematic review and meta-analysis – ongoing
  • S Talic et al – Risk factors associated with nonadherence and adherence to lipid lowering terries in Australian adults in primary health practices: a retrospective cohort study – ongoing
  • S Talic et al – Barriers and enablers to adherence to lipid lowering therapies in primary CVD prevention: a qualitative study – ongoing
  • S Talic et al – Development of an evidence-based clinical decision support tool to address medication’s nonadherence – ongoing
  • S Talic et al – Stakeholder acceptability of incorporating the clinical decision tool to address medication’s nonadherence in for primary healthcare provision in Australia – ongoing